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High Priorities: Better Patient Care, Enhanced Physician Support

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High Priorities: Better Patient Care, Enhanced Physician Support

High Priorities: Better Patient Care, Enhanced Physician Support

Manisha Patel, medical director of the Johns Hopkins Outpatient Center Dermatology Clinic, examines a patient’s moles with a dermatoscope. The Department of Dermatology has brought its “bump” rate down to under 1 percent, allowing it to serve patients better.

Date: 09/01/2015

The care was “high quality,” but the wait time “interminable.” That’s what one Johns Hopkins patient responded when asked to comment on a recent visit.

Patients frequently praise the quality of the Johns Hopkins care they receive, but too many note they spend a lot of time cooling their heels in the waiting room. Excessive wait times diminish patient satisfaction and signal inefficiency, both of which can hurt the bottom line.

For these reasons, cutting wait times is a key ambulatory priority for FY2016. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey, which measures multiple aspects of the care experience, asks patients if they saw their provider within 15 minutes of the appointment time. Some 70 percent of patients said yes on recent surveys, placing the health system in the 14th percentile nationally for this dimension. Patients were surveyed from multiple Johns Hopkins Hospital-affiliated sites, including the Johns Hopkins Outpatient Center. The responses of Johns Hopkins Community Physicians (JHCP) patients are not included in these data, as JHCP uses a different version of the CG-CAHPS.

“We already provide high-quality care. But we have to do a better job providing a high-quality patient experience,” says John Flynn, vice president of the Office of Johns Hopkins Physicians (OJHP) and executive director of the Clinical Practice Association.

Flynn and his OJHP colleagues have established nine ambulatory priorities, divided into four categories:

  • Patient service excellence
  • Physician support
  • Quality and safety
  • Operational excellence

“The context here is that more and more, we are expected to deliver metrics around quality, safety and operations to regulatory agencies and to the public. With Epic, we can get a lot more information about our clinicians and their practices to satisfy those demands and make sure we’re running clinics efficiently,” Flynn says.

Patient Service Excellence

The CG-CAHPS wait-time measure and another CG-CAHPS measure, about whether clinicians provided timely test results, compose the patient service excellence category. The goal for FY2016 is to increase by 3 percentage points the proportion of respondents saying they saw a provider within 15 minutes of the appointment time and the proportion answering “always” when asked if their physician’s office provided timely test results.

“If a physician’s office doesn’t provide timely test results, that’s a potential source of medical error. So we’re aiming for the ‘always’ experience. It’s what our patients deserve,” says Lisa Allen, chief patient experience officer for Johns Hopkins Medicine.

Physician Support

There are three physician support goals: 98 percent of transcriptions available within 48 hours, at least two Thrive After Go-Live classes per month, and two cohorts per year of eight to 10 dyads or triads in the Ambulatory Management Program (AMP). By incorporating Lean methodology and focusing on effective leadership and problem-solving, AMP provides clinical leaders with the knowledge and skills required to enhance ambulatory care delivery.

“Our job in the Office of Johns Hopkins Physicians is to give our clinicians and clinical faculty members tools to help them do their jobs,” says Flynn.

Operational Excellence

This category comprises two goals: No more than 3 percent of patient appointments should be canceled by the provider less than 30 days before the appointment date, and 99 percent of encounters should be closed within 14 days.

Dermatology is one department that has brought down its late-cancellation rate, also known as the “bump” rate. A high bump rate compromises patient care and satisfaction, and can affect revenue if patients go elsewhere for care.

Illness and family emergencies drive most late cancellations, says Manisha Patel, medical director of the Johns Hopkins Outpatient Center Dermatology Clinic. But some doctors forget to cancel a clinic in advance, even when they know they will be traveling at that time.

“We’re trying to encourage providers to plan in advance,” Patel says. When a physician in the Department of Dermatology wants to cancel clinic, he or she has to submit the request to the chairman’s office. If the clinic must be canceled, patients are given the option of keeping their appointment but seeing another provider so that there is no delay in their evaluation.

The effort has been a success. Dermatology’s bump rate is now less than 1 percent.

The other metric in this category, finishing clinical notes within 14 days, is to facilitate better care and better communication between physicians, says Flynn.

Quality and Safety

Patient-reported compliance with hand hygiene protocols is the first metric in this category. The goal is that in at least 90 percent of patient encounters, physicians are observed by patients practicing effective hand hygiene.

The second metric is blood pressure control for patients with hypertension. For patients 18 to 59 and for those 60 or over who have diabetes, the target is that at least 74 percent have a reading less than 140/90mm Hg. For older patients without diabetes, the target is that 74 percent will have a reading less than 150/90mm Hg. Reaching that goal would put Johns Hopkins in the 80th percentile nationally. Controlling blood pressure is an effective way to reduce the chances of heart attack and stroke.

“If we can make improvements in hypertension rates, it will also improve other aspects of the patient’s health,” says Jenny Bailey, senior director of quality and transformation for the OJHP.

Pulling It All Together

Metrics fatigue can set in when there are too many metrics to satisfy, says Flynn. “By winnowing the list down to nine priorities from two or three times as many, we’re attempting clarity. We want our physicians to focus on these.”

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